Facing a conviction for insurance fraud in Pennsylvania can be overwhelming. You could face jail time and fines, damage to your personal reputation, a civil suit against you from victims or insurance companies, and possible loss of a professional license. But if you already have a conviction on your record, you may be looking ahead to how this can affect you personally and professionally over the long term. In Pennsylvania, you can clean up your record by limiting public access to your records through sealing. You may qualify for automatic sealing by the state, or you may qualify to petition the court to limit public access to your insurance fraud records.
Pennsylvania Statute for Insurance Fraud
Pennsylvania's insurance fraud statute is extensive, addressing everything from fraud to false claims and soliciting claims. You may face charges for insurance fraud in Pennsylvania if you:
- File or present a document with false, incomplete, or misleading information regarding a material fact related to a state or local government agency's determination in approving a car insurance rate filing or insurance transaction, knowingly and with intent to defraud,
- Knowingly and with intent to defraud an insurer, present a statement forming a part of, or in support of, a claim containing false, incomplete, or misleading information regarding a fact material to a claim,
- Knowingly and with the intent to defraud an insurer, assist, abet, solicit, or conspire with someone else to make a statement to an insurer in connection with or in support of a claim containing false, incomplete, or misleading information regarding a fact material to a claim, including making claims over the actual loss sustained by a claimant,
- Engage in “unlicensed agent, broker, or unauthorized insurer activity” with the “intent to defraud an insurer” or the public.
- Knowingly benefiting from the proceeds gained from violating this statute due to the “assistance, conspiracy or urging of any person,”
- Are the “owner, administrator or employee of any health care facility and knowingly” allow someone to use the facility in “furtherance of a scheme or conspiracy to violate any of the provisions of this section,”
- Borrow or use another person's insurance information or allow someone else to use your insurance information with the “intent to present a fraudulent claim to an insurer,”
- Directly or indirectly solicit someone else to retain you or another to prosecute or adjust a claim against another for negligence or solicit someone to bring a cause of action “to recover damages for personal injuries or death,” for gain for yourself or someone else.
18 Pa. Stat. § 4117 (1995).
The insurance fraud statute also prevents:
- A lawyer from compensating a non-lawyer to recommend their services or solicit or secure clients outside of advertising or nonprofit referral services,
- A healthcare provider from compensating anyone to recommend or secure the provider's services outside of the reasonable cost of advertising allowed by the professional rules of conduct,
- A lawyer or health care provider from compensating anyone for names, addresses, and other identifying information of people seeking or receiving medical care for an accident, sickness, or disease except as allowed by the professional rules of conduct,
- Others from giving patient information to a lawyer or health care provider to receive compensation, including their employees, and
- Filing an insurance application containing false information or concealing material facts intending to defraud an insurer.
Penalties for Insurance Fraud in Pennsylvania
The grading of an insurance fraud charge will vary based on the circumstances but can range from a misdemeanor to a felony under Pennsylvania law. But you can also be ordered to provide restitution to an insurer or victim and face additional financial penalties in court. Pennsylvania's insurance fraud statute expressly permits an insurance company, insurer, or other victims to bring a civil action against you for violating the criminal statute.
- Insurance Fraud Misdemeanor Penalties Insurance fraud is a first-degree misdemeanor if a lawyer or health care provider compensates someone else for recommending their services to someone else, obtaining clients on their behalf, or providing names, addresses, and identifying information of patients seeking treatment for an accident, injury, or illness. If someone provides this information to an attorney or health care provider in exchange for compensation, it's also a first-degree misdemeanor. Under Pennsylvania law, a first-degree misdemeanor is punishable by a fine of $1,500 to $10,000 and up to five years in prison. Attorneys and health care providers can also face additional professional repercussions with a conviction for insurance fraud in Pennsylvania. The statute specifically directs the prosecutor to refer attorneys to the disciplinary board of the Supreme Court: Upon a conviction of an offense provided for by this paragraph, the prosecutor shall certify such conviction to the disciplinary board of the Supreme Court for appropriate action. Such action may include a suspension or disbarment. The statute also directs the prosecutor to refer medical professionals to the licensing board in their state for suspension or revocation of their license: Upon a conviction of an offense provided for by this paragraph, the prosecutor shall certify such conviction to the appropriate licensing board in the Department of State, which shall suspend or revoke the health care provider's license.
- Insurance Fraud Felony Penalties Insurance fraud is a third-degree felony for any additional offenses under the statute. Under Pennsylvania law, a third-degree felony is punishable by a fine of $2,500 to $15,000 and up to seven years in prison.
Sealing Criminal Records Through Clean Slate
Pennsylvania's easiest option for record sealing is the state's Clean Slate legislation, where the state will automatically seal your records after five to ten years if you qualify. You may qualify for automatic sealing if:
- Your insurance fraud conviction is only for a second-degree or third-degree misdemeanor or a summary offense,
- You don't have a conviction for insurance fraud because the charges were dropped, or the court found you not guilty, or
- Your conviction is for an ungraded offense or misdemeanor punishable by two years or less in jail.
Because a first-degree misdemeanor conviction for insurance fraud is punishable by up to five years in prison, you probably won't qualify for automatic sealing under Clean Slate.
Sealing Your Insurance Fraud Record with an Act 5 Petition
If you have a first-degree misdemeanor conviction for insurance fraud that isn't eligible for automatic sealing under Clean Slate, you can still petition the court to seal your records under Act 5. Act 5 isn't an automatic process but applies to a broader range of criminal convictions. You may be eligible to petition for Act 5 sealing if:
- You wait ten years after completing your sentence, including paying all fines,
- Your insurance fraud conviction is a misdemeanor or ungraded offense punishable by five years or less in prison, and
- You don't have any additional arrests or prosecutions for more crimes punishable by a year or more in jail.
Pennsylvania law does not allow you to seal a felony conviction for insurance fraud. However, you should consult an experienced sealing and expungement attorney to discuss other options.
You Need a Skilled Pennsylvania Sealing Attorney
If you have a conviction for insurance fraud on your record and you're trying to figure out your best option to clean it up, you need an experienced sealing and expungement attorney. Our experienced Criminal Law Team has been helping people in Pennsylvania seal and expunge their records for years, and we can help you too. Call the LLF Law Firm at 888-535-3686 to schedule your consultation, or contact us online today.
